Making a case for using MDMA-assisted psychotherapy for borderline personality disorder and complex PTSD: a descriptive systematic review of the literature
Karthika Kasiviswanathan, Dinuli Nilaweera, M Morando, Sathya Rao, J Lee, Joseph Fettling, Jillian H. Broadbear
Therapeutic Advances in Psychopharmacology July 1, 2026 DOI: 10.1177/20451253251408626 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Descriptive systematic review Peer reviewed |
|---|---|
| Sample size | 335 |
| Population | Participants in studies of MDMA-assisted psychotherapy for PTSD, complex PTSD, or borderline personality disorder |
| Intervention | MDMA-assisted psychotherapy |
| Topics | MDMA Psychedelic-assisted therapy PTSD |
| Keywords | Borderline personality disorder Psycinfo Abandonment legal Dissociative identity disorder Medline Interpersonal communication Suicidal ideation Clinical psychology Psychotherapist Psychopathology Systematic review Comorbidity Interpersonal psychotherapy |
| Key findings | MDMA-assisted psychotherapy may have applicability beyond PTSD, with potential benefits for complex PTSD and borderline personality disorder, though no studies directly assessed these conditions. |
Abstract
Background: 3,4-Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy (MDMA-AP) has demonstrated considerable efficacy in treating post-traumatic stress disorder (PTSD). PTSD and complex PTSD (CPTSD) frequently co-occur with borderline personality disorder (BPD), a complex disorder marked by emotional dysregulation, interpersonal difficulties and abandonment fears - often accompanied by suicidal and non-suicidal self-injury. While MDMA-AP is beneficial for PTSD and hypothesised to be effective for BPD, its application to CPTSD and BPD has not been systematically reviewed.
Objectives: To systematically evaluate primary evidence on the use of MDMA-AP in treating PTSD, CPTSD, and BPD.
Design: Descriptive systematic review. Data sources and
Methods: A systematic search of four databases (Ovid Medline, Embase, APA PsycINFO and CENTRAL) identified 24 eligible peer-reviewed studies published before 17 February 2025. Risk of bias and data extraction were conducted independently using standardised methods.
Results: Of the 24 studies involving 335 participants, 15 reported outcomes from seven clinical trials, four were case reports, and five were non-randomised interventions. Four studies included participants with multiple forms of trauma, and three included those with dissociative PTSD. Most reported reduced PTSD symptoms post-intervention; some noted decreased dissociative symptoms at higher MDMA doses. Six studies did not exclude participants with BPD. Although none directly assessed MDMA-AP for CPTSD or BPD, improvements in emotional regulation, interpersonal functioning, identity coherence and abandonment concerns were reported. Adverse drug reactions were mild to moderate, although specific safety concerns remain.
Conclusion: Findings from this review suggest that MDMA-AP may have applicability beyond PTSD, with potential benefits for CPTSD and BPD, offering preliminary insights to inform future research and clinical considerations. Protocol
Registration: PROSPERO ID: CRD42025594896.